Accuracy of cardiac output measurements during off-pump coronary artery bypass grafting: according to the vessel anastomosis sites

다국어 초록 (Multilingual Abstract)

Background: During beating heart surgery, the accuracy of cardiac output (CO) measurement techniques may be influenced by several factors. This study was conducted to analyze the clinical agreement among stat CO mode (SCO), continuous CO mode (CCO), arterial pressure waveform-based CO estimation (APCO), and transesophageal Doppler ultrasound technique (UCCO) according to the vessel anastomosis sites.
Methods: This study was prospectively performed in 25 patients who would be undergoing elective OPCAB. Hemodynamic variables were recorded at the following time points: during left anterior descending (LAD) anastomosis at 1 min and 5 min; during obtuse marginal (OM) anastomosis at 1 min and 5 min: and during right coronary artery (RCA) anastomosis at 1 min and 5 min. The variables measured including the SCO, CCO, APCO, and UCCO.
Results: CO measurement techniques showed different correlations according to vessel anastomosis site. However, the percent error observed was higher than the value of 30% postulated by the criteria of Critchley and Critchley during all study periods for all CO measurement techniques.
Conclusions: In the beating heart procedure, SCO, CCO and APCO showed different correlations according to the vessel anastomosis sites and did not agree with UCCO. CO values from the various measurement techniques should be interpreted with caution during OPCAB.

다국어 초록 (Multilingual Abstract)

Background: During beating heart surgery, the accuracy of cardiac output (CO) measurement techniques may be influenced by several factors. This study was conducted to analyze the clinical agreement among stat CO mode (SCO), continuous CO mode (CCO), arterial pressure waveform-based CO estimation (APCO), and transesophageal Doppler ultrasound technique (UCCO) according to the vessel anastomosis sites.
Methods: This study was prospectively performed in 25 patients who would be undergoing elective OPCAB. Hemodynamic variables were recorded at the following time points: during left anterior descending (LAD) anastomosis at 1 min and 5 min; during obtuse marginal (OM) anastomosis at 1 min and 5 min: and during right coronary artery (RCA) anastomosis at 1 min and 5 min. The variables measured including the SCO, CCO, APCO, and UCCO.
Results: CO measurement techniques showed different correlations according to vessel anastomosis site. However, the percent error observed was higher than the value of 30% postulated by the criteria of Critchley and Critchley during all study periods for all CO measurement techniques.
Conclusions: In the beating heart procedure, SCO, CCO and APCO showed different correlations according to the vessel anastomosis sites and did not agree with UCCO. CO values from the various measurement techniques should be interpreted with caution during OPCAB.

참고문헌 (Reference)

1 이지연, "심장 수술 중 폐동맥 카테터를 이용한 지속적인 심박출량 감시의 정확성" 대한마취통증의학회 54 (54): 603-608, 2008

2 de Waal EE, "Validation of a new arterial pulse contour-based cardiac output device" 35 : 1904-1909, 2007

3 Laupland KB, "Utility of esophageal Doppler as a minimally invasive hemodynamic monitor: a review" 49 : 393-401, 2002

4 Lorsomradee S, "Uncalibrated arterial pulse contour analysis versus continuous thermodilution technique: effects of alterations in arterial waveform" 21 : 636-643, 2007

5 Dark PM, "The validity of trans-esophageal Doppler ultrasonography as a measure of cardiac output in critically ill adults" 30 : 2060-2066, 2004

6 Connors AF Jr, "The effectiveness of right heart catheterization in the initial care of critically ill patients. SUPPORT Investigators" 276 : 889-897, 1996

7 Bland JM, "Statistical methods for assessing agreement between two methods of clinical measurement" 1 : 307-310, 1986

8 Böttiger BW, "Semi-continuous versus injectate cardiac output measurement in intensive care patients after cardiac surgery" 22 : 312-318, 1996

9 Schober P, "Perioperative hemodynamic monitoring with transesophageal Doppler technology" 109 : 340-353, 2009

10 Spahn DR, "Noninvasive versus invasive assessment of cardiac output after cardiac surgery: clinical validation" 4 : 46-59, 1990

11 Boldt J, "Is continuous cardiac output measurement using thermodilution reliable in the critically ill patient?" 22 : 1913-1918, 1994

12 Nishikawa T, "Hemodynamic status susceptible to slowing of heart rate during thermodilution cardiac output determination in anesthetized patients" 18 : 841-844, 1990

13 Odenstedt H, "Descending aortic blood flow and cardiac output: a clinical and experimental study of continuous oesophageal echo-Doppler flowmetry" 45 : 180-187, 2001

14 Thrush D, "Continuous thermodilution cardiac output: agreement with Fick and bolus thermodilution methods" 9 : 399-404, 1995

15 Bein B, "Comparison of esophageal Doppler, pulse contour analysis, and real-time pulmonary artery thermodilution for the continuous measurement of cardiac output" 18 : 185-189, 2004

16 Singh A, "Comparison of continuous, stat, and intermittent cardiac output measurements in patients undergoing minimally invasive direct coronary artery bypass surgery" 16 : 186-190, 2002

17 "Comparison of Uncalibrated Arterial Pressure Waveform Analysis with Continuous Thermodilution Cardiac Output Measurements in Patients Undergoing Elective Off-Pump Coronary Artery Bypass Surgery" Elsvier Inc 24 (24): 767-771, 2010

18 Moxon D, "Clinical evaluation of the HemoSonic monitor in cardiac surgical patients in the ICU" 31 : 408-411, 2003

19 Button D, "Clinical evaluation of the FloTrac/Vigileo system and two established continuous cardiac output monitoring devices in patients undergoing cardiac surgery" 99 : 329-336, 2007

20 "Change in right ventricular function during off-pump coronary artery bypass graft surgery" 25 : 572-577, 2004

21 Mehta Y, "Cardiac output monitoring: comparison of a new arterial pressure waveform analysis to the bolus thermodilution technique in patients undergoing off-pump coronary artery bypass surgery" 22 : 394-399, 2008

22 de Waal EE, "Cardiac output monitoring" 22 : 71-77, 2009

23 Biais M, "Cardiac output measurement in patients undergoing liver transplantation: pulmonary artery catheter versus uncalibrated arterial pressure waveform analysis" 106 : 1480-1486, 2008

24 Lafanechère A, "Cardiac output measurement during infrarenal aortic surgery: echo-esophageal Doppler versus thermodilution catheter" 20 : 26-30, 2006

25 Chand R, "Cardiac output estimation with a new Doppler device after off-pump coronary artery bypass surgery" 20 : 315-319, 2006

26 Mayer J, "Cardiac output derived from arterial pressure waveform analysis in patients undergoing cardiac surgery: validity of a second generation device" 106 : 867-872, 2008

27 Lucchetti V, "Beating heart coronary revascularization without metabolic myocardial damage" 14 : 443-444, 1998

28 Mathison M, "Analysis of hemodynamic changes during beating heart surgical procedures" 70 : 1355-1360, 2000

29 Opdam HI, "A pilot assessment of the FloTrac cardiac output monitoring system" 33 : 344-349, 2007

30 Critchley LA, "A meta-analysis of studies using bias and precision statistics to compare cardiac output measurement techniques" 15 : 85-91, 1999